An
ultrasound is done before a D&E to determine the
size of the uterus and the number of weeks of the pregnancy.

A
device called a
cervical (osmotic) dilator is often inserted in the
cervix 24 hours before the procedure to help slowly open (dilate) the cervix.
Dilating the cervix reduces the risk of any injury to the cervix during the
procedure. Misoprostol may also be given several hours before surgery. This
medicine can help soften the cervix.

D&E usually takes 30
minutes. It is usually done in a hospital but does not require an overnight
stay. It can also be done at a clinic where doctors are specially trained to
perform abortion. During a D&E procedure, your doctor will:

Give you a pain medicine
injection in the cervical area (paracervical block) along with a
sedative. If the procedure is done in an operating
room, you could receive a spinal anesthesia injection into the fluid around the
spinal cord. This numbs the area between your legs. Or your doctor may use
general anesthesia, which makes you
unconscious.

Grasp the cervix with an instrument to hold the uterus
in place.

Dilate the cervical canal with probes of increasing
size. An abortion in the second 12 weeks will need the cervix to be dilated
more than required for a
vacuum aspiration.

Pass a hollow tube
(cannula) into the uterus. The cannula is attached by tubing to a bottle and a
pump that provides a gentle vacuum to remove tissue in the uterus. Some
cramping is felt during the rest of the procedure.

Pass a grasping
instrument (forceps) into the uterus to grasp larger pieces of tissue. This is
more likely in pregnancies of 16 weeks or more and is done before the uterine
lining is scraped with a curette.

Use a curved instrument (curette)
to gently scrape the lining of the uterus and remove tissue in the
uterus.

Use suction. This may be done as a final step to make sure
the uterine contents are completely removed.

Give you a medicine to
reduce the amount of bleeding from the procedure.

The uterine tissue removed during the D&E is examined
to make sure that all of the tissue was removed and the abortion is
complete.

Doctors may use ultrasound during the D&E procedure
to confirm that all of the tissue has been removed and the pregnancy has
ended.

What To Expect After Surgery

Dilation and evacuation (D&E) is a
surgical procedure. A normal recovery includes:

Irregular bleeding or spotting for the first 2
weeks. During the first week, avoid tampons and use only pads.

Cramps similar to menstrual cramps, which may last from several
hours to a few days, as the uterus shrinks back to its nonpregnant
size.

Emotional reactions for 2 to 3 weeks. After an abortion, it is normal to feel relief, sadness, grief, or guilt.
Hormonal changes during pregnancy can make emotions stronger than usual.

After the procedure

Antibiotics are given to prevent
infection.

Rest quietly that day. You can do normal activities the
following day, based on how you feel.

Acetaminophen (such as
Tylenol) or ibuprofen (such as Advil) can help relieve cramping
pain.

Medicines may be given to help the uterus contract and return
to its prepregnancy size.

Do not have sexual intercourse for at
least 1 week, or longer, as advised by your doctor.

When you
start having intercourse again, use birth control. And use condoms to prevent
infection. To learn more, see
the topic
Birth Control.

Signs of complications

Call your doctor immediately if you have
any of these symptoms after an abortion:

Severe bleeding. Both medical and surgical
abortions usually cause bleeding that is different from a normal menstrual
period. Severe bleeding can mean:

Passing clots that are bigger than a
golf ball, lasting 2 or more hours.

Soaking more than 2 large pads
in an hour, for 2 hours in a row.

Bleeding heavily for 12 hours in
a row.

Signs of infection in your whole body, such as
headache, muscle aches, dizziness, or a general feeling of illness. Severe
infection is possible without fever.

Severe pain in the belly
that is not relieved by pain medicine, rest, or heat

Hot flushes or a fever of
100.4°F (38°C) or higher that
lasts longer than 4 hours

Vomiting lasting more than 4 to 6
hours

Sudden abdominal (belly) swelling or rapid heart
rate

Vaginal discharge that has increased in amount or smells
bad

Pain, swelling, or redness in the genital area

Call your doctor for an appointment if you have had any of these symptoms after a recent
abortion:

Bleeding (not spotting) for longer than 2
weeks

New, unexplained symptoms that may be caused by medicines
used in your treatment

No menstrual period within 6 weeks after the
procedure

Signs and symptoms of
depression. Hormonal changes after a pregnancy can
cause depression that requires treatment.

Why It Is Done

Dilation and evacuation (D&E) is
one of the methods available for a second-trimester abortion. A D&E is done
to completely remove all of the tissue in the uterus for an abortion in the
second trimester of pregnancy.

A D&E is sometimes recommended for women
diagnosed in the second trimester with a fetus that has severe medical problems
or abnormalities.

A woman who is pregnant as a result of rape or
incest may not confirm the pregnancy until the second trimester because of her
emotional reaction to the traumatic cause of the pregnancy.

A
woman who doesn't have access to an affordable abortion specialist in her area
or whose access is slowed by legal restrictions may take several weeks to have
a planned abortion. When an abortion is delayed, a D&E may be
necessary.

How Well It Works

Dilation and evacuation is a safe and
effective method. It has become the standard treatment of care in the United
States for an abortion in the second trimester of pregnancy.

Risks

The risks of dilation and evacuation (D&E)
include:

Injury to the uterine lining or
cervix.

A hole in the wall of the uterus (uterine perforation). This is rare. This most commonly happens during cervical dilation. In the second trimester, bleeding may be more likely, and a repair may be needed. If bleeding is a concern, a
laparoscopy (a procedure that uses a lighted viewing
instrument) can be used to see whether it has stopped.

Infection.
Bacteria can enter the uterus during the procedure and cause an infection. This
is more likely if an untreated infection, such as a
sexually transmitted infection (STI), is present before
the procedure. Antibiotics given during and after the D&E procedure will
reduce this risk.

Moderate to severe bleeding (hemorrhage), which
is sometimes caused by:

Injury to the uterine lining or
cervix.

Uterine perforation.

Uterine rupture. In rare cases, a uterine incision scar tears
open when a medicine is used to induce contractions.

Tissue remaining in the uterus (retained products of
conception).

Risks are higher for surgical abortions done in the second
trimester of pregnancy than for those done in the first trimester, particularly
if they are done after 16 weeks of pregnancy.

Other rare
complications include:

Tissue remaining in the uterus (retained
products of conception). Cramping belly pain and bleeding recur within a
week of the procedure. Sometimes prolonged bleeding does not occur until
several weeks later.

Blood clots. If the uterus doesn't contract to
pass all the tissue, the cervical opening can become blocked. This prevents blood
from leaving the uterus. The uterus becomes enlarged and tender, often with
belly pain, cramping, and nausea.

A repeat
vacuum aspiration and medicine to stop bleeding are
used to treat retained products of conception or blood clots.

What To Think About

An abortion is unlikely to affect
your fertility, so it is possible to become pregnant in the weeks right after
the procedure. Avoid sexual intercourse until your body has fully recovered,
for at least 1 week or as advised by your doctor. When you do start having
intercourse again, use birth control, and use condoms to prevent
infection.

Counseling for a second-trimester abortion may be more
involved than for an early abortion because of the length of the pregnancy and
the reason for the abortion.

Should you have continuing
emotional reactions after an abortion, seek counseling
from a grief counselor or other licensed mental health professional.

Depression can be triggered when pregnancy hormones
change after an abortion. If you have more than 2 weeks of symptoms of
depression, such as fatigue, sleep or appetite change, or feelings of sadness,
emptiness, anxiety, or irritability, see your doctor about treatment.

The hospital or surgery center may send you instructions on how to get
ready for your surgery or a nurse may call you with instructions before your
surgery.

Right after surgery, you will be taken to a recovery
area where nurses will care for and observe you. You will probably stay in the
recovery area for a period of time and then you will go home. In addition to
any special instructions from your doctor, your nurse will explain information
to help you in your recovery. You will go home with a page of care instructions
including who to contact if a problem arises.

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